Healthcare's weighty problem


I'm going to start my not phat odyssey with Kaiser Permanente going into cahoots with the purveyor of mildly charming mobsters, bayou vampires and dwarf royalty.

The end result was "The Weight of the Nation," a four-part documentary aired earlier this month on HBO in collaboration with Kaiser. It possessed ambitions that outmatch its message: America is fat. Too fat.

Unfortunately, anyone who only takes a mildly curious glance around a shopping mall or schoolyard might have figured that out already.

The issue has been so intractable of late that television--the longtime showcase of those thin enough to walk through the cracks in closed doors--has begun featuring beefier people, via "Weight of the Nation" and elsewhere. "Glee" and "Modern Family" are two recent examples that come to mind. Ironically, HBO's "Sopranos," the most extensive study of self-delusional individuals ever undertaken by American culture, had been the most honest in portraying the problem. Many cast members required zoning variances. 

Yet if TV is becoming fairly open on this topic, it means we have a real problem. And since obesity is a primary driver of healthcare costs, it is becoming an extremely serious debate.

One of the issues being discussed is levying a tax on foods that cause obesity. The website for the British Medical Journal recently argued that such a tax would need to be at least 20 percent to effectively improve health. "Ideally, this should be combined with subsidies on healthy foods such as fruit and vegetables," the article said.

Such a tax has been proposed in a variety of states, and the pushback from food processors has been predictably ferocious. And based on my personal experience, I doubt that would work anyway.

What is my experience? As a junior in high school, I weighed nearly 300 pounds. I was absolutely miserable (some might argue that hasn't changed). I was going to enter adulthood as a second-class citizen and was profoundly depressed and angry about it. My life felt completely out of my control. I decided I could try and control one thing: Food.

It took four years, but by the time I was a junior in college, I had dropped more than 100 pounds. I weigh about 20 pounds more than in those days, but my weight generally stays in an acceptable zone for someone of my height and age.

I was extraordinarily fortunate: Most studies suggest adolescence is one of the few periods of life where someone can take off a lot weight and keep it off.

However, most people are not in that particular situation. And fashioning a food tax like the current tobacco tax is not practical. You can quit smoking altogether. You can't stop eating. And the dread, hope, anxiety and the other maelstrom of emotions that dictate food choice, eating and overeating are simply too complex to extinguish with a higher purchase price.

"Food can be my best friend," said a ruefully tearful Vivia Armstrong, a 27-year-old resident of Atlanta who weighs 341 pounds, during a "Weight of the Nation" interview. "Food can be my boyfriend at the moment. Food can be a vacation to the beach when I can't afford to go."

For anyone who has never battled weight and looks down on those who do, Armstrong's remarks contain more truth than the most primly arranged stack of Bibles.

That's not to say everyone is doomed. Yolanda Neal, a caterer featured in "Weight of the Nation" was so heavy that the scale in her doctor's office could not accommodate her (she weighed 430 pounds). She dropped about 80 pounds through a weight loss program at Washington University. Much of that was achieved by fixing little things, like skipping a McDonald's 32 ounce sweet tea (280 calories, more than a Snickers bar).

But Neal noted that America wants a quick fix to its weight problem. "People don't want to hear eat more fruits and vegetables and … less fried food. It's like a boring story," she said. "No action. It's not a thriller."

There are things that can be done that would have the same effect as a tax increase but with better results. One of the biggest shifts in food culture in this country occurred in the 1970s. In order to fight inflation in commodity prices, sugar processing moved its extraction from cane and beets to the more plentiful and cheaper corn. However, 100,000 years of human metabolic rates were based on beet and cane sugar consumption; it was not prepared for a wholesale shift that occurred in little more than a decade.

If agricultural policies shifted back to encouraging beet and cane sugar extraction and subsidies returned to the old model of paying farmers not to grow excess commodities (rather than encouraging overproduction), prices would rise and the end product might be more easily metabolized.

Mandating that sugary drinks are not sold in portions larger than eight ounces also would help. We all consume on average about 300 extra calories than we need--virtually all of it from beverages. Half-liter bottles of Coke and juice do nothing but encourage overconsumption.

Of course, if America suddenly veered onto a healthier path, hospital finances would be impacted. There would be less of a need for cardiac catheterization labs, diabetic and renal care programs, and bariatric surgery centers.

But then again, the time spent planning all these programs could definitely be put to better use: Like bugging the feds to pay more on Medicaid and Medicare. - Ron (@FierceHealth)

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